Browsing by Author "Shrestha, Sailesh"
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Publication Anti-Glomerular Basement Membrane Disease in a 10-year-old Child: A Case Report(Nepal Medical Association, 2023) Anjum, Md Firoz; Twanabasu, Sajal; Shrestha, Sailesh; Lama, Tashi Anjuk; Magrati, DipendraAbstract Anti-glomerular basement membrane disease is an extremely uncommon entity in children. It has an incidence of 0.5 to 1 per million per year in adults and is even more uncommon in children. It occurs due to autoantibody against glomerular basement membrane collagen and is characterized by rapidly progressive glomerulonephritis with or without pulmonary hemorrhage. As the literature on anti-glomerular basement membrane disease is limited from our part of the world, it is important to consider it as the rare cause of rapidly progressive glomerulonephritis as early intervention improves prognosis. We report a case of a 10-year-old male who initially presented with glomerulonephritis and later was diagnosed with anti-glomerular basement membrane disease.Publication Neonatal Sequential Organ Failure Assessment Score to Predict Mortality in Neonatal Intensive Care Unit at Tertiary Care Center(Nepal APF Hospital, 2025) K.C., Ganesh; Shah, Ganesh; Chalise, Shiva Prasad; Shrestha, Bijesh; Shrestha, Sailesh; Gautam, Tilak; Khanal, IneshAbstract: Background: The Neonatal Sequential Organ Failure Assessment (nSOFA) score is a tool used to evaluate degree of organ dysfunction in critically ill neonates admitted to neonatal intensive care units (NICUs). The nSOFA score is based on respiratory, cardiac and hematological parameters (total score ranges from 0 to 15). This study aims to evaluate the applicability of nSOFA score to predict neonatal mortality in NICU of Patan Hospital. Methods: This prospective observational study was conducted at the NICU of Patan Hospital, Lalitpur, Nepal from May 2023 to November 2024. The parameters of nSOFA score were recorded at admission and between 48-72 hours of admission. Data were analyzed using EPI-INFO and Easy R software. Results: Among 134 neonates, 105 (78%) survived, and 29 (22%) did not. At admission, a nSOFA score ≥4 had a sensitivity of 69%, specificity of 91.4%, positive predictive value (PPV) of 69% and negative predictive value (NPV) of 91.4% for predicting mortality. At 48-72 hours, a cutoff score of ≥5 showed a sensitivity of 75.7%, specificity of 99%, PPV of 96.6% and NPV of 91.4%. Conclusion: The nSOFA score is a important tool for predicting neonatal mortality in NICUs and can be used to guide clinical decision-making.Publication Platelet Indices as Predictive Marker of Prognosis in Critically IllChildren Admitted to Pediatric Intensive Care Unit: An ObservationalStudy(Nepal APF Hospital, 2026) Shrestha, Sailesh; K.C., Sri Ram; Gautam, Tilak; Khanal, Inesh; Shrestha, Sheshna; Pradhan, BulbulAbstract: Introduction: Platelets play a key role in hemostasis and inflammatory processes. Routinely available platelet indices, platelet count, mean platelet volume, platelet distribution width, and plateletcrit may serve as useful prognostic markers in critically ill children. This study aimed to evaluate their role using routine complete blood count tests. Methods: A one-year prospective observational study was conducted in the Pediatric Intensive Care Unit of a tertiary hospital in Nepal from May 2023 to April 2024. Ethical approval was sought from the Institutional Review Committee (Ref: PMP2305161725). A convenience sampling technique was used. Platelet indices were compared with mortality, need for mechanical ventilation, inotropes, and hospital stay, using Receiver Operating Characteristic analysis to identify predictive cut-off values. Data were managed using Epidemiologic Information, Microsoft Excel, and Easy R. Results: Marked differences in platelet indices were noted across clinical outcomes. Survivors had significantly higher platelet count (270.75 ± 136.06) and plateletcrit (0.37 ± 0.15) than non-survivors (130.25 ± 86.72 and 0.21 ± 0.12, respectively; p < 0.001). Patients requiring inotropes had lower platelet count (184.32 ± 114.57) and plateletcrit (0.27 ± 0.16), but higher Mean platelet volume, platelet distribution width, and platelet distribution width-to-platelet count ratio (p < 0.001). Similarly, those requiring invasive mechanical ventilation had lower platelet count (195.01 ± 125.30) and plateletcrit (0.29 ± 0.16), but higher mean platelet volume and platelet distribution width-to-platelet count ratio (p < 0.001). Platelet count had the highest sensitivity (90.30%) for predicting mortality, while platelet distribution width had the highest specificity (86.7%). The platelet distribution width-to-platelet count ratio showed good sensitivity (77.40%) and specificity (79.20%) at a cutoff of 0.09. Conclusions: Platelet indices are valuable prognostic markers for critically ill children. However, further research with larger sample sizes, multicenter designs, and serial monitoring of platelet indices is needed to validate these findings.